HOME >> MEDICINE >> NEWS
Doctors steer sick patients away from capitated HMOs

Quality concerns drive inadvertent 'cherry picking'

Many doctors unwittingly are helping managed care plans cherry pick healthier patients, while sicker patients are being steered toward safety-net providers, according to a new study.

In a national survey of 787 physicians, 40 percent reported encouraging patients who are sicker or who have more complex illnesses to avoid capitated managed care plans, in which doctors receive a flat monthly rate per patient. At the same time, 23 percent reported encouraging healthier patients to join such plans, finds the study published in the January issue of the Journal of General Internal Medicine.

Although the data dont clearly identify whether it is cost or quality considerations alone that motivate them to make such recommendations, the study shows that physicians are contributing to risk selection among capitated managed care plans, raising legal, ethical and policy issues, according to author Matthew K. Wynia, M.D., M.P.H., of the American Medical Associations Institute for Ethics.

On the one hand, medical leaders have suggested that physicians ought to help their patients make [health plan] selections, because assisting patients in this way is an important form of physician advocacy, the authors note.

Unfortunately, this study shows that even well-intentioned physician advice may foster risk selection, say Wynia and colleagues. Risk selection undermines insurance pools by causing disproportionate enrollment of less costly patients into certain health plans. This is expensive for some payers, who overcompensate health plans with healthier-than-expected enrollees and financially risky for providers who do not or cannot risk-select, such as safety net providers.

Physicians also were asked whether they felt capitated payment plans undermined their ability to offer a quality of care equal to that of other types of managed care reimbursement. One-third of the surveyed
'"/>

Contact: Ross Fraser
312-464-4443
Center for the Advancement of Health
12-Jan-2002


Page: 1 2

Related medicine news :

1. Doctors need to prepare for blood shortages now
2. Doctors must consider potentially inappropriate medications when treating elderly
3. Doctors transplant ovary to womans arm to preserve fertility
4. Doctors can improve colorectal cancer screening rates
5. Doctors miss chances to provide diet, exercise counseling to patients at risk of heart disease
6. Doctors and patients call on politicians to save lives of cancer patients
7. Doctors dont agree on diagnosis of uterine cancer
8. Doctors at Northwestern Memorial are studying next generation surgery for back pain sufferers
9. U-M study: Doctors more likely to prescribe pricey new blood pressure drugs
10. Doctors over-estimate survival of terminally ill patients
11. Doctors are often strongly affected by patient deaths

Post Your Comments:
*Name:
*Comment:
*Email:


(Date:6/27/2016)... ... June 27, 2016 , ... ... health professionals, announced today its affiliation with Tennessee Counseling Association. This ... the network of the Tennessee Counseling Association, adding exclusive benefits and promotional offers. ...
(Date:6/26/2016)... ... June 26, 2016 , ... On June 10-11, 2016, A ... 2016 Cereal Festival and World’s Longest Breakfast Table in Battle Creek, MI, where the ... history as home to some of the world’s leading providers of cereal and other ...
(Date:6/25/2016)... D.C. (PRWEB) , ... June 25, 2016 , ... ... discuss health policy issues and applications at AcademyHealth’s Annual Research Meeting June 26-28, ... their work on several important health care topics including advance care planning, healthcare ...
(Date:6/25/2016)... ... June 25, 2016 , ... As a lifelong Southern Californian, Dr. Omkar Marathe ... from the David Geffen School of Medicine at UCLA. He trained in Internal Medicine ... his fellowship in hematology/oncology at the UCLA-Olive View-Cedars Sinai program where he had the ...
(Date:6/24/2016)... ... 24, 2016 , ... Those who have experienced traumatic events may suffer from ... avenues, such as drug or alcohol abuse, as a coping mechanism. To avoid this ... coping following a traumatic event. , Trauma sufferers tend to feel a range of ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... , June 24, 2016 Research and ... Market for Companion Diagnostic Tests" report to their offering. ... for Companion Diagnostics The World Market for ... personalized medicine diagnostics. Market analysis in the report includes the ... Market (In Vitro Diagnostic Kits) by Region (N. America, EU, ...
(Date:6/23/2016)... , June 23, 2016  MedSource announced ... as its e-clinical software solution of choice.  This ... best possible value to their clients by offering ... The preferred relationship establishes nowEDC as the EDC ... for MedSource,s full-service clients.  "nowEDC has long been ...
(Date:6/23/2016)... , June 23, 2016 Roche (SIX: RO, ... clearance for its Elecsys BRAHMS PCT (procalcitonin) assay as ... or septic shock. With this clearance, Roche is the ... fully integrated solution for sepsis risk assessment and management. ... bacterial infection and PCT levels in blood can aid ...
Breaking Medicine Technology:
Cached News: